Centre of Excellence

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Out of crime and into service

Out of crime and into service

Respect and integrity

Respect and integrity

Tackling alcohol abuse

Tackling alcohol abuse

Promoting prevention

Promoting prevention

Delivering value for money

Delivering value for money

Accessibility

Accessibility

Drug treatment

Drug treatment

Challenging stigmas and equality

Challenging stigmas and equality

Learning partnership

Learning partnership

Targeting offenders

Targeting offenders

Improving access treatment

Improving access treatment

Responsiveness

Responsiveness

Improving wellbeing

Improving wellbeing

Strengthening workforces

Strengthening workforces

D E T O X I F I C A T I O N

S T A B I L I S A T I O N

R E H A B I L I T A T I O N

South Staffordshire and Shropshire HealthcareNHS Foundation Trust

South Staffordshire andShropshire Healthcare

NHS Foundation Trust

adults andcommunities

Ending dependency, transforming lives

working in partnership with service users

Heart of BirminghamTeaching Primary Care Trust

Heart of BirminghamTeaching Primary Care Trust

























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Contents03 Introduction

04 The Partnership 05 The Commissioning Body

06 The Consortium

06 Inclusion Drug Alcohol Services

06 Phoenix Futures

07 Midland Heart

07 Rehabilitation and After Care Team (RACT)

08 The Centre of Excellence 10 The Staff Structure

10 Staff Structures – organisational charts

10 RACT Team

11 Roles and Responsibilities

12 Accessing services 12 Referral and Assessment

13 Referral and Assessment Flowchart

14 The Treatment 14 Detoxification

14 Stabilisation

14 Preparation for Rehabilitation

14 Rehabilitation

15 Moving Forward 15 Continuing Care

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IntroductionThis document outlines the proposed treatment programme of activity within the Tier 4 ‘Centre of Excellence’: a partnership between Birmingham Drug and Alcohol Action Team (BDAAT), Birmingham City Council (BCC), Inclusion Drug Alcohol Psychological Services, Phoenix Futures and Midland Heart.

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The PartnershipBirmingham Drug and Alcohol Action Team (BDAAT)

and Birmingham City Council secured capital funding

from the National Drug Treatment Agency (NTA) that

led to the development of the ‘Centre of Excellence’, a

creative and innovative approach to residential drug

and alcohol treatment due to open in May 2010.

This led to the creation of a consortium:

Inclusion Drug Alcohol Services, part of South Staffordshire •

and Shropshire Healthcare NHS Foundation Trust.

Phoenix Futures - who successfully gained the contract •

to provide specialist treatment intervention services.

Midland Heart - who provide the premises.•

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The Commissioning BodyBirmingham Drug and Alcohol Action Team (BDAAT) is part of both the Safer Birmingham Partnership and Health and Well Being Partnership. It is comprised of all the main statutory agencies including Health, Birmingham City Council, Primary Care Trusts, National Offender Management Service, Prisons and Voluntary Service.BDAAT commissions drug and alcohol treatment services on behalf of the partnership. BDAAT’s remit is to reduce the harm caused by drugs and alcohol in order to improve health and well-being. BDAAT approaches this through strategic co-ordination, collaborative action, pooled resource investment, and the commissioning of evidence based, effective, quality services.

BDAAT oversees the quality of treatment provided and assesses what is needed each year through a Needs Assessment and Treatment Planning process. The aim is to ensure that drug and alcohol users are given safe and appropriate treatment options that can support them to overcome their addiction issues in the long term.

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The Consortium

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Inclusion Drug Alcohol ServicesSouth Staffordshire and Shropshire Healthcare NHS Foundation Trust achieved ‘Foundation Trust of the Year’ in 2008. Since it was established in 2001 when three smaller Trusts joined together, the Trust has provided mental health and drug and alcohol services which link health and social care responses to service users and criminal justice needs.

Inclusion Drug Alcohol Services is part of the Specialist Services Directorate of the Trust. Inclusion was established in 2002 to meet the needs of people with drug and alcohol issues.

Inclusion currently provides a range of drug alcohol services within prisons and the community. We work in prisons across the Midlands and South of England, providing community services in Birmingham and Swindon. We also provide psychological therapies throughout the city of Liverpool.

Inclusion works within clinical guidelines and recognised models of good practice to deliver services that aim to minimise drug/alcohol related harm for drug/alcohol users and their families and the wider community. We place a high emphasis on involving service users, their families and their friends when developing services.

Phoenix FuturesPhoenix Futures is the leading provider of care and rehabilitation services for people with drug and alcohol problems in the UK. Through 40 years experience of transforming lives we have developed a diverse portfolio of services across community, prisons and residential settings.

As a national charity treating over 13,000 people a year for substance misuse, we are a leading provider of rehabilitation services. Phoenix Futures runs residential rehabilitation services across the UK, including adult services in Sheffield, Wirral, Tyneside, Glasgow and Hampshire; a women only service at Portland House (Newark); and two family services based at Sheffield and Brighton.

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Midland HeartMidland Heart is one of the top ten regeneration groups in the country and the largest based in the Midlands. Every year we invest more than £100 million in improving homes, building new ones and making neighbourhoods more desirable and sought after places to live.

We are passionate about communities and our vision is to create opportunity, enthuse residents and become one of the most efficient providers of affordable housing and community investment services.

Rehabilitation and After Care Team (RACT)Birmingham City Council has been providing defined substance misuse residential rehabilitation services for over fifteen years. The RACT has grown incrementally in that time and now provides a comprehensive substance misuse service, specialising in assessment for rehabilitation programmes and, following residential treatment, continuity of care to support on-going recovery.

The RACT is part of the Vulnerable Adults Division, which is in the Adults and Communities Directorate. We believe a multi-disciplinary perspective allows us to work flexibly, in partnership with all substance misuse treatment providers in Birmingham.

We are proud to work in collaboration with service users, their parents and carers, and as a result have developed many individual bespoke programmes, which in turn have fostered a thriving peer support group network. This, we believe, is due to our unique continuing care programming.





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The Centre of ExcellenceThe 18-bedded unit provided by Midland

Heart will be located at 15 Park Road South,

Hockley, Birmingham. The building is due

to be completed by May 2010. It will house

the delivery of stabilisation, detoxification

and rehabilitation treatment interventions

on a residential and community basis.

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Location of the Centre of Excellence

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The Staff StructureInclusion Drug Alcohol Services, Phoenix Futures and Birmingham City Council Adults and Communities Directorate, will combine their resources of six distinct staff skill groups to provide residential and community treatment intervention services to drug and alcohol service users in need of Tier 4 treatment in Birmingham. The staff skill groups will include nursing staff (RMN and RGN), medical and psychiatric doctors, rehabilitation workers, social workers, clinical psychologists and peer supporters.

All staff will receive a structured induction. They are required to participate in mandatory training and additional specialist training in the various addictions and issues that may present. All staff will be DANOS competent and will have or be working towards a minimum NVQ 3 qualification.

Three organisations will be working together in partnership in the Centre to deliver a multi-disciplinary approach to managing the health, social and therapeutic intervention of the clients that receive treatment on a residential and a community day care basis.

The charts and table overleaf illustrate staffing structures within the new service, and the roles and overall responsibilities of the professionals involved.

Staff Structures – organisational charts

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Administrator1.0 WTE

Administrator0.5 WTE

Service ManagerBand 8a

INCLUSION

Team Manager1.0 FTE

Drug Workers5.5 FTE

Sessional Workers10hrs/FTE

Service Manager1.0 FTE

PHOENIX FUTURES

Nurse Team Manager1.0 WTE Band 7

Nurse Team Leader1.0 WTE Band 6

Nurses7.0 WTE

Health & Social Care Workers 6.0 WTE

Lead Specialist Prescriber0.5 WTE

Specialist Prescriber0.4 WTE/Sessions

Clinical Psychologist0.5 WTE Band 8b

Clinical Psychologist Assistant 1.0 WTE

RACT TeamManager

Holly Road1.0 WTE

Team Manager0.5 WTE

(Covered by Senior Prac.)

Substance MisuseOperations Manager

0.5 WTE

Administrator 1.0 WTE

Senior Practitioner (AMHP)0.5 WTE

Senior Social Worker 1.0 WTE

Senior Social Worker (AMHP)

1.0 WTE

Social Worker1.0 WTE

Senior Social Worker (AMHP)

1.0 WTE

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Roles and Responsibilities ROLE AREA OF RESPONSIBILITY

Inclusion Drug Alcohol Services

Inclusion Service Manager

Overall responsibility for the units operation, partnerships and strategic development

Nurse Team Manager

Day to day management of the clinical services and ensuring the highest levels of clinical practice is maintained

Nurse Team Leader Responsible for ensuring that service user care and the team are fully supported

Lead Prescriber Responsible for the high standards of clinical practice and service user safety within the unit

Administrator Reception and administration for the Centre of Excellence and ensuring that the unit runs efficiently

Specialist Prescriber

Provision of specialist medical care to service users

Principal Clinical Psychologist

Providing specialist psychological interventions and provision of action research within the unit to provide continuous improvement

Assistant Psychologist Practitioner

Provision of low range psychological interventions and undertaking core action research activities

Nurses Round the clock nursing care to service users undergoing detoxification or stabilisation

Health and Social Care Workers

Responsible for day to day social support and activities within the centre

Phoenix Futures

Administrator Reception and administration for the Centre of Excellence

Service Manager Ensuring that leadership and management of the rehabilitation treatment services, in conjunction with our partners, are provided to the highest possible standards and ensure that the treatment approaches and interventions are appropriate, innovative and fully meet the needs of both clients and stakeholders

Team Manager Management of the multi-disciplinary team responsible for the delivery of a comprehensive rehabilitation programme with emphasis on assisting residents transition back into independent living within the community

Rehabilitation Workers

Responsible for the delivery, development, and evaluation of the core therapeutic programme make sure that residents' care plan targets are met ensuring a smooth transition into independent living

Rehabilitation and After Care Team

Social Workers Responsible for the initial assessment into the Rehabilitation Programme to ensure Community Care Act/FACS Banding & Financial compliance. Undertaking a 28 day review and involvement in the Discharge Planning Review. Responsible for After-Care Planning, providing Care Co-ordination following completion of residential treatment

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Accessing services The Centre will work closely with treatment providers, service users,

their families and carers to share knowledge and understanding on

treatment criteria, access into treatment, treatment interventions

and activities. This will be achieved by using digital media to

ensure that information is readily available and accessible to the

widest audience. In conjunction with this there will be stakeholders

and service user’s involvement workshops, where they can

participate in the shaping of the Tier 4 centre and its services.

This approach is intended to increase the knowledge of the

Tier 4 service to referring agencies and service users.

We are currently filming activities that will form part of

the website to distribute the programme to all.

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Referral and AssessmentProcesses must be adequate and streamlined to unlock resources and produce efficiency savings. Key to this is ensuring that clinicians and service users are informed about Tier 4 criteria and the programme.

Considerable resources in terms of people and paperwork can be expended on inappropriate referrals and duplication of processes leading potentially to blockages, an unsatisfactory service user experience and inter agency tensions.

The flowchart on the next page illustrates how the referral process will enable treatment providers to access the Tier 4 service.

All referrals from professionals will be accepted for assessment. The service user will have a lead care coordinator in the community.

In order to minimise delays in processing referral forms, treatment providers will need to ensure that the following documentation is provided:

comprehensive assessment•

risk assessment•

current care plan•

a relapse plan•

‘continuity of care’ plan for •detox service users.

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Referral and Assessment Flowchart

Prior to referral the treatment provider will need to ensure that they have identified a continual care plan and have contingency arrangements in place should the service user be discharged before treatment completion. This is crucial to managing risk for service users referred.Monitoring of the quality of referrals and level of additional information supplied will be recorded and fed back to commissioners and senior managers within treatment services to engender continuous improvement.

On receipt of all the referral and appropriate information, service users will be invited to the pre-assessment clinic. Stabilisation referrals will automatically be deemed high risk and therefore fast-tracked to assessment and will not be expected to attend pre-assessment sessions.

The pre-assessment clinic will be delivered by staff and peer supporters. It will act as a screening facility for the Tier 4 service and provide an opportunity for the service user to tour the facility and find out more about the treatments available and the expectations of treatment. During the visit service users will be given the opportunity to book assessment appointments.

The residential assessment will be conducted by a multi-disciplinary team and include a medical and psycho-social assessment. A care plan will also be developed with the service user during this meeting identifying both the preparation and treatment needs of the individual. The assessing member of staff, in collaboration with the service user will agree the best package of care to meet the service user’s needs. A multi disciplinary team will decide on admission priority. The assessor will retain care-coordination responsibility of the service user throughout their treatment within the Centre in conjunction with the referral agency, who will retain overall care-coordination during the service user’s treatment journey, through to continuing care when they leave the Centre.

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Intake Multi disciplinary meeting

Providers referral to unitNot suitable for unit – referred back to treatment provider

Service user screening and information session

Inclusion medical assessment

Integrated assessment by Phoenix Futures and RACT

Stabilisation

Detox

Rehabilitation

Refer to continual care

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The TreatmentThe drug and alcohol stabilisation and detoxification programmes go beyond medical or psychological treatment. Our aim is to facilitate social reintegration by providing a range of daily physical and cognitive activities that the service user can participate in whilst being stabilised and or detoxified.

The rehabilitation programme will be flexible to accommodate residential or community based service users. It offers a short stay intensive therapeutic based service that will address self responsibility, self management, self understanding and self effectiveness to achieve an outcome of abstinence recovery from substance dependence.

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Detoxification This is a medical process which enables the body to become drug/alcohol free. All individuals are managed on a 24-hour basis by supervised and qualified staff. The time taken to complete this treatment is variable depending on the severity of problems and the profile of drugs the individual is trying to come off.

Stabilisation Stabilisation is a medically managed process for individuals in medical and psychological crisis, and who need structured medical care within a period of effective assessment and monitoring. All individuals are managed on a 24 hour basis by supervised and qualified staff. This process can take up to a week.

Preparation for RehabilitationThe aims of the preparation for rehabilitation are as follows:

Encourage service user •responsibility for their rehabilitation plan and work with services in partnership to achieve this outcome.

One preparatory session •which focuses on maximising service user responsibility by exploring their needs both during rehab and exiting rehab into recovery.

Within the above •session the boundaries, house rules and disciplinary procedures are discussed and explained. The management of boredom is also explored with the service user.

This session covers the •journey from rehab into recovery with a ‘what happens next’ which allows the service user to consider an alternative lifestyle free form substance misuse.

RehabilitationThe process of rehabilitation enables the individual to overcome social and psychological barriers to prevent reusing drugs and/or alcohol. This includes learning about overcoming triggers and cravings, providing peer support and treatment provision in the prevention of relapse. This also includes facilitating entry into employment and training and most importantly identifying suitable accommodation and housing related support. Rehabilitation is a more complex psychological and social change that will typically continue long after the person has stopped experiencing physical effects and is the supportive process of protecting ex-substance users against the risk and temptation of relapse.

The therapeutic model aims to fulfil a range of needs and provide a joined up ‘wraparound’ intervention.

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Moving Forward Continuing CareFollowing treatment at the Centre service users will have planned departures into continuing supported treatment which will have been devised as part of their initial care plan.

They will have maintained contact with their care-coordinator who made the referral. This will assist in the transition from Tier 4 to continuing aftercare. Structured pathways into supported housing facilities and floating support funded by Supporting People will be developed in partnership between the Tier 4 Centre and other providers to assist the transition for service users from Tier 4 into continuing care. The Centre will have its own peer support network, including a network for parents and carers of service users.

Birmingham Drug and Alcohol Action Team. Contact Mike Quinn – telephone 0121 465 4980

www.bdaat.co.uk







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Centre of Excellence

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t i o nsouth staffordshire

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care team ract08

moneydelivering value

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